2nd Sem PEDIATRICS Prelims (2014-2015)

Nephrology - (20 items)

1. Normal Fluid vascular component? 3 to 4 LITERS2. Interstial component? 2 to 3 LITERS3. Basic test used in screening patient with renal disease?

URINALYSIS4. Oliguria? <500mL for 24hrs5. Polyuria? >2000mL for 24rs6. Telescope urine sediment signifies? RENAL FAILURE7. Hematuria seen in? BOTH FEVER AND EXERCISE8. Alkaline urine except? MEAT DIET9. AGN S/Sx? HEMATURIA< PROTEINURIA, PYURIA10. Below 90th percentile of age, height? NORMAL BP

Nephrolotic Syndrome (10 Items)

1. Diagnosis of UTI includes:a. Historyb. Physical examinationc. Laboratory examinationd. All of the above

2. Overall risk among symptomatic female patients with UTIa. 1-2%b. 3-5% c. 5-7%d. 7-9%

3. Causative organism among 70-90% of UTI casesa. E. Coli b. S. Saprophyticusc. S. Hemolyticusd. Klebsiella Oranea

4. Significant residual bladder volume that predisposes to recurrent UTI

a. 3% b. 5%c. 7%d. 9%

5. Defined as having BP of >/95th percentile for age, gender, height confirmed on 3 separate occasions

a. Borderline HPNb. PreHPNc. Hypertension d. Severe Hypertension

6. Children at risk for hypertension are those with:a. DMb. Obesityc. History of umbilical catheterizationd. All of the above

7. Drug classification of furosemide as BP lowering agenta. Diuretic vasodilator

b. Beta blockerc. Loop diuretic d. Ace inhibitor

8. Primary acquired glomerulonephritisa. Post infectious glomerulonephritisb. Focal segmental glomerulonephritis c. IgA nephropathyd. Anti-GBM nephritis

9. 80% of minimal change nephrotic syndrome present at this age group:

a. 1-6 yo b. 6-10 yoc. 10-15 yod. 16-20 yo

10. Mainstay of nephrotic syndrome therapya. Ace inhibitorsb. Corticosteroids c. Alkylating agentsd. Lavamsole?

PRELIMS 20121. A 20 year old mother is about to deliver her baby and on

biophysical profile, they found out that she had polyhydramnios? The following condition might be expected the baby to have

a. Renal agenesis - oligohydrmniosb. Duodenal atresia c. Lung hypoplasia – oligohydramnios d. Potter syndrome - oligohydramnios

2.What would be the best way of assessing gestational age of the baby if you have a 10 week old pregnant mother. a. crownrump length via ultrasound b. femoral length via ultrasound c. biparietal diameter via ultrasound d. quickeningCrown-rump length obtained between 6 and 12 weeks’ gestation biparietal diameter, after 12 weeks is accurate within 10 days; beyond 26 weeks, accuracy diminishes to > 3 weeks.

3. A mother experiences “quickening” of the baby. The approximate age of gestation is said to be?a. 10 weeksb. 16 weeks c. 20 weeksd. 30 weeks>quickening at 16-18 weeks

4 The New Ballard Score is best examined up to 96 hour, if > 26 weeks . It composed of the followinga. Neuromuscular maturity signb. Physical maturity signc. Both d. A only

5. APGAR SCORE are taken on the 1st and 5th minutes of life. A low APGAR score at 5 minutes of life connotes what probable condition?

a. poor resuscitationb. possible neurological deficit/sequelae c. no effectd. sepsis

6. A 24 week , preterm baby was delivered in a taxi, you will have a quick assessment of the age of gestation. You immediately look at the baby’s foot for creases and noted that there is none. How would you asses the gestational age of this preterm?

a. illuminate the footb. measure the foot from heel to toe c. check for lanugo hair distributiond. heel to ear maneuver

7. At Medical Center Manila, a newborn baby was delivered via normal spontaneous delivery. Please plot the following data and classify. BW 4.2 kg BS 41 weeks (2 points)

a. Term, Appropriate age of gestationb. Post term, Small for gestational agec. Term, Large for gestational age d. Post term , Large for gestational age

8. A baby 30 weeks of gestation with a weight of 1.2 kg. Plot and classify the baby according to age of gestation. (2 points)

a. Preterm Appropriate age of gestation b. Term, Small for gestational agec. Term appropriate for gestational aged. Preterm, small for gestational age

9. An 8-year old boy is found to have a height measurement of 110 cm. What is his height age?

a. 3 yearsb. 6 yearsc. 10 yearsd. 8 years

10. A bone-age of less than 4 years in a child who is 8 years old is very likely due to:

a. Nutritional deficiencyb. An endocrine causec. Normal variation in growthd. Genetic of familial causes

11. A 14 year old female consults for shortness and lack of secondary sex characteristics. You suspect Turner syndrome. Which of the following best supports your impression?

a. History of edema of the hands and feet in the newborn period

b. A positive response to growth hormone administrationc. Very marked webbing of the neck on PEd. An XO karyotype

12. Which of the following is usually the earliest sign of sexual menstruation in a female?

a. Sudden growth spurt

b. Onset of menstrual periodsc. Appearance of breast budsd. Appearance of pubic hair

13. A 9 year old male gives a history of traumatic delivery and hypoglycemic seizures. On PE he is found to have a weight of 25 kg and a height of 110cm. This child should be worked up for which of the following condition?

a. Congenital hypothyroidismb. Growth hormone deficiency?(not sure)c. Cushing syndromed. Trisomy 21

14. Which of the following causes of shortness is the least stunting?a. Growth hormone deficiencyb. Congenital hypothyroidismc. Turner syndromed. Precocious puberty (di ko sure)

15. Which of the following inhibit the secretion of growth hormone?a. Cortisolb. β-adrenergic blockersc. Insulind. Dopamine

16. A 12 year old girl has a height of 120cm, an upper to lower segment ratio of 2:1 and a bone age of 6 years. What is your most likely diagnosis?

a. Intrauterine growth retardationb. Growth hormone deficiencyc. Constitutional delay in growth and developmentd. Congenital hypothyroidism ?(not sure)

17. A 16 year old male with a height of 120cm, a very positive upper to lower segment ratio, a large head and normal sexual development very likely has:

a. Congenital hypothyroidismb. Mucopolysaccharidosisc. Achondroplasia?(not sure)d. Vitamin D resistant rickets

18. A 10 year old female with a height of 130 cm whose mother is 5 ft 2 in and whose father is 5 ft 7 in has a bone age which is normal for chronological age. What will be her final height at 18 years?

a. 157.3 +/-5 cmb. 150 +/- 5cmc. 145 +/- 5cmd. 160 +/-5 cm

19. A 16 year old hypothyroid female on follow-up has a pulse rate of 72/min, increased TSH, decreased Free T4 and decreased Free T3. Which of the following steps will you take?

a. Decrease her dose of thyroidb. Increase her dose of thyroidc. Leave her dose of thyroid as isd. Repeat thyroid function test and tell her to return

20. A 12 year old hyperthyroid male returns for follow up after 3 months and is found to have normal TSH, a normal Free T4 and a normal Free T3. The patient is asymptomatic, has no subjective complaints and gained 1 kg since his last check-up. Which of the following are you going to do?

a. Increase his dose of methimazoleb. Decrease his dose of methimazolec. Prescribe an adrenergic β-blockerd. Leave his management as is

21. The most common cause of congenital hypothyroidism due to dishormonodysgenesis is a defect in which of the following steps in the production of thyroid hormones?

a. Deiodinationb. Organificationc. Couplingd. Iodine trapping

22. A 14-year old girl with a history of thyroid enlargement for the past 6 months is found to have a single nodule by palpation. The nodule is very firm and non-tender. On technetium scan, the nodule has no uptake and you suspect a malignancy. If you are right, the most probable histopathologic diagnosis would be:

a. Papillary cancer (cold)b. Poorly differentiated or anaplastic carcinomac. Follicular carcinoma (hot)d. Medullary carcinoma

*B or D?? ewan

23. The most commonly used marker or test in the post-ablation follow-up of thyroid carcinoma is:

a. FT3 and FT4b. Thyroid ultrasoundc. Tc scan of the thyroidd. Serum thyroglobulin levels

24. A 14-year old girl has a weight of 75 kg and height of 152cm has a BMI of:

a. 32.6b. 28c. 25.7d. 35

25. Which of the following is a required component of the proposed definition of Metabolic syndrome in children?

a. Blood pressure of 140/90 (130/85)b. Fasting blood sugar >130 mg/dL (110)c. BMI >90th percentile (obese na to, dapat overweight

lang?)d. HDL <50

31. A 4 year old child has serum Calcium levels of >12 mg/dL and low levels of Mg and P. Which of the following hormonal assays will you request for?

a. Thyroidb. Parathyroidc. Calcitonind. Insulin

32. A 24 hour old premature infant with a history of asphyxia is seen for generalized seizures. Serum Ca is 5 mg/dL. One of the more common causes which should be investigated is:

a. Hypoparathyroidism associated with mitochondrial disorders

b. Idiopathic hypoparathyroidismc. Maternal hyperparathyroidismd. Autoimmune hypoparathyroidism

33. A long term complication of hyperparathyroidism is:a. Calcification of the basal ganglia

b. Intestinal obstructionc. Diabetes mellitusd. Nephrocalcinosis

34-38. Match the conditions in Column A with the usual laboratory findings associated that are in Column B

Column A Column BF 34. Diabetes Mellitus a. sNa 124 K. 5.8 blood glucose 210E 35. Diabetes Insipidus b. sNa 146 K 3.4 blood glucose 56G 36. Adrenal Insufficiency c. HgbA1c 5.1 blood glucose 124 Na 146D 37. Obesity d. SGOT 63 HgbA1c 7.1% Cholesterol 321H 38. Congenital Adrenal Hyperplasia e. sNa 156 urine specific gravity 1.003

f. HgbA1c 8.2% sNa 128 blood glucose 41g. sNa 124 K5.8 blood glucose

54h. sNa 127 K 5.9 17OH Progesterone >300

39. An 8 year old boy consults you for evaluation of his short stature and is found to be just at the 5th % for height on the NCHS growth curve. On follow-up visit 6 months later, the interval growth is 2.6 cm. What advise should you give the parents?a. The patient has to be further evaluated as he is still about the

5th %b. The patient can be reassured that he is growing at a constant

ratec. The patient should have thyroid studies doned. The patient needs to be evaluated for possible growth hormone

deficiency

40. A 9 year old boy is brought to you with complaint of weight loss, polyuria, and polydipsia. You are suspecting diabetes mellitus. Which of the following screening tests will give you the most diagnostic information?

a. Random blood sugar, HgbA1cb. Urinalysis, random blood sugarc. Venous blood gas, urine ketonesd. Random blood sugar, C-peptide level

41. Which of the following conditions will cause ambiguous genitalia in a genetic male?

a. 3-betahydroxysteroid dehydrogenase enzyme deficiencyb. CVAH secondary to 21-hydroxylase deficiencyc. CVAH secondary to 11-beta hydroxylase deficiencyd. none of the above (LAHAT FOR FEMALE)

42. Which of the following are medical consequence of obesity?a. T2DM, pseudotumor cerebri, depression, hypothyroidismb. T2DM, obstructive sleep apnea, hypertension, Blount’s

diseasec. T2DM, hepatitis, growth hormone deficiency, depressiond. T1DM, obstructive sleep apnea, hepatitis, hypoparathyroidism

43. How is BMI calculated?a. weight in pounds/height in cm2b. height in m2/weight in kgc. height in cm2/weight in poundsd. weight in kg/height in m2

44. At what BMI percentile is achild or adolescent considered to be overweight?

a. BMI >50%b. BMI >75%

c. BMI >85%d. BMI>95% (obesity)

45. Which of the following is a convincing observation that a child’s growth is pathologica. height is <5th%b. deceleration in linear growth across 2 percentile channelsc. height at >2SD below the midparental heightd. all of the above

46. A 15 year old undergoes a water deprivation test. The starting serum sodium was 142 meq/L and closest urine specific gravity to this determination was 1.005. Into the 5th hour of water deparivation, serum sodium was 158 meq/L and urine specific gravity was 1.005. A dose of desmopressin (ADH) was given, and 2 hours later, serum sodium in 148 meq/L and urine specific gravity was 1.010. What is the correct diagnosis?

a. Compulsive water drinkingb. Central diabetes insipidusc. Nephrogenic diabetes insipidusd. Diagnosis cannot yet be established

47. A 7 year old girl from Ilocos Norte was incidentally found to have hyperglycemia. She has been asymptomatic: no polyuria, polydipsia, polyphagia, weakness or weight loss. The doctor in Ilocos started her in Lispro insulin 70/30 12 units pre-breakfast and 6 units pre-dinner. The blood sugar readings have now been in the 70-110 range and family wants to know if she truly has diabetes mellitus. What test will you do to assess if she truly has diabetes mellitus. What test will you do to assess is she has remaining insulin secretory capacity?

a. Oral glucose tolerance testb. IV glucose tolerance testc. C-peptide leveld. Serum insulin level

48. Which of the following genetic conditions has short status as one of its features:

a. Marfan’s syndromeb. Klinefelter syndromec. Grave’s diseased. Prader Willi syndrome

49. What is the test that will allow you to assess remaining potential for bone growth?

a. Serum IGF-1 levelb. Bone agec. Random growth hormone leveld. Osteocalcin

50. Which of the following associations will provide best potential for growth?

a. Height age>bone age>chronological ageb. Height age>chronological age>bone agec. Bone age>Chronological age>Height aged. Chronological age>Bone age>Height age

51. Which zone of the adrenal cortex is primarily responsible for synthesis of adrenal androgens?

a. zona reticularisb. zona glomerulosac. zona fasciculatad. zona tubularis

52. A 6 year old female has had asthma for 3 years and has been taking oral prednisone 20 mg BID for 2 week periods almost every other week, Budesonide inhaler 2x/day for 5 months. At a general pediatric clinic visit, you notice she has gained a lot of weight (12kg in 8 months) but has grown 1 cm. What is your diagnosis

a. Growth hormone deficiencyb. Iatrogenic Cushing’s syndromec. Cushing’s Diseased. Growth failure from hypoxemia due to reactive airway

disease

53. What conditions are tested for in the Newborn Screening test?a. Congenital hypothyroidism, Congenital Adrenal

Hyperplasia, Galactosemia, Phenylketonuria, G6PD deficiencyb. Congenital hypothyroidism, Congenital Adrenal

Hyperplasia, Galactosemia, Maple syrup urine disease, G6PDc. Congenital hypothyroidism, Congenital Adrenal

Hyperplasia, Maple syrup urine disease, Phenylketonuria, G6PD deficiency

d. Congenital hypothyroidism, congenital lipid dystrophy, galactosemia, phenylketonuria, G6PD deficiency

54. What is currently the most common cause of cirrhosis?a. Hepatitis Bb. Drug-induced hepatitisc. Non-alcoholic steatohepatitisd. Alcoholic hepatitis

55. When should the hormonal evaluations of a newborn with ambiguous genitalia be undertaken?

a. Before 2 months of ageb. Before 2 years of agec. Before 12 years of aged. the age of evaluation is not important

• Diagnostic evaluation should be performed in an organized and expeditious manner. Critical blood samples should be obtained PRIOR to administration of gluccorticoids, gonadotropins, and androgens levels obtained before 2 mos of age.

56. What is the determinant of the differentiation along male line?a. Y chromosomeb. H-Y antigenc. Testes determining factord. SRY gene

57. What is the clinical feature which distinguishes primary (adrenal) from secondary (pituitary):

a. hyperpigmentation is observed in primary AI and not in secondary AI

b. hyperpigmentation is observed in secondary AI and not in primary AI

c. obesity is often observed in primary AI and not in secondary AI

d. obesity is often observed in secondary AI and not in primary AI

58. What is the desirable glycosylated Hgb level for patients with T1DM, which according to the DCCT trial will reduce the incidence of chronic complications by 50-75%?

a. 6%b. 7%

c. 8%d. 9%

Instructions: For items 59-63: from among the lettered choices below, choose the best answer.A. SGAB. IUGRC. Both of the aboveD. Neither of the above

59. Statistical definition- C60. Suggests an intrauterine pathology- C61. Less than the 12th percentile weight for age- D62. Seen among premature infants- 63. Seen among term infants

For items 64-68: from among the lettered choices below, choose the best answer.A. LGAB. Infant of a diabeticC. Both of the aboveD. Neither of the above

64. Statistical definition- A65. Greater than the 95th percentile weight for age- C66. Seen among premature infants67. Seen among term infants68. May be further classified into symmetric or asymmetric